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Effect of Pneumococcal Vaccination and Other Factors on Prognosis in Patients Following with Pneumonia in Geriatric Clinic

Year 2021, Volume: 11 Issue: 2, 238 - 245, 29.06.2021
https://doi.org/10.31832/smj.779500

Abstract

Amaç: Çalışmamızın amacı pnömoni tanısı ile geriatri servisimizde izlenen hastaları analiz etmek ve enfeksiyon öncesi aşı durumunun sorgulanarak aşının prognoza etkisini tartışmaktır.
Gereç ve Yöntemler: Çalışmaya Ocak 2017- Aralık 2017 tarihleri arasında geriatri kliniğinde pnömoni nedeniyle takip edilen hastalar alındı. Hastaların demografik verileri, semptomları, fizik muayene bulguları, laboratuvar tetkikleri ve radyolojik incelemeleri kayıt altına alındı. Pnömoni gelişimi öncesinde pnömokok aşısının yapılıp yapılmadığı değerlendirildi. Hastaları prognoz yönünden 'iyi' ve 'kötü' olarak sınıflandırıldı. Kötü prognoz göstergeleri, enfeksiyona eşlik eden septik şok bulgularının varlığı, yoğun bakım ihtiyacı veya enfeksiyonun başlamasından sonraki 30 gün içinde ölüm olarak belirlendi.
Bulgular: Bir yıllık sürede servise yatırılan 186 hastanın 47’sinde (%25) yatışında veya yattığı sürede pnömoni saptandı. Pnömoniyi düşündüren akciğer grafisi bulgularının oranı %87 ve oskültasyon bulgularının oranı % 83 idi. Dispne (p=0,008) ve mental bozukluğun olması (p<0,001) kötü prognoz için anlamlı istatistiksel fark oluşturmaktaydı. KÜSK-65 (Konfüzyon, üremi, solunum sayısı, kan basıncı, 65 yaş üstü) (p=0,030) ve PŞİ (pnömoni şiddet indeksi) (p=0,013) skoru kötü prognozlu olanlarda anlamlı olarak daha yüksekti. Aşı olanlar olmayanlara göre istatistiksel olarak anlamlı, daha iyi prognozluydu (p=0,003). Kaybedilen 7 hasta da aşı olmamıştı.
Sonuç: Bu çalışma geriatrik popülasyonda, aşılamanın gerekliliğini ve prognoz üzerine olumlu etkisini göstermiştir.

References

  • 1. Crossley KB, Peterson PK. Infections in the elderly. Clin Infect Dis 1996;22(2):209–215. doi:10.1093/clinids/22.2.209.
  • 2. Lyons PG, Kollef MH. Prevention of hospital-acquired pneumonia. Curr Opin Crit Care 2018;24(5):370–378. doi:10.1097/MCC.0000000000000523. 3. Küçükardalı Y, Öncül O, Nalbant S ve ark. Yaşlı populasyonda toplum kökenli pnömoni olguları. Geriatri 2001; 4: 59-62.
  • 4. Hyattsville MD. Advance report of final mortality statistics: monthly vital statistics report: National Center for Health Statistics, 1987; DHHS publication no (PHS) 87-1120.
  • 5. Türk Toraks Derneği Erişkinlerde Toplumda Gelişen Pnömoni Tanı ve Tedavi Uzlaşı Raporu Türk Toraks Dergisi, 2009.
  • 6. Şenol E, Azap A, Erbay A et al. Pneumococcal vaccine as one of the immunization coverage targets for adulthood vaccines: A consensus report of the Study Group for Adult Immunization of the Turkish Society of Clinical Microbiology and Infectious Diseases]. Klimik Derg 2018.
  • 7. Cillóniz C, Amaro R, Torres A. Pneumococcal vaccination. Curr Opin Infect Dis 2016;29(2):187–196. doi:10.1097/QCO.0000000000000246.
  • 8. Berical AC, Harris D, Dela Cruz CS et al. Pneumococcal Vaccination Strategies. An Update and Perspective. Ann Am Thorac Soc 2016;13(6):933–944. doi:10.1513/AnnalsATS.201511-778FR.
  • 9. Sings HL. Pneumococcal conjugate vaccine use in adults - Addressing an unmet medical need for non-bacteremic pneumococcal pneumonia. Vaccine 2017;35(40):5406–5417. doi:10.1016/j.vaccine.2017.05.075.
  • 10. Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML. A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients. Am J Med 2000;108(8):609-613. doi:10.1016/s0002-9343(00)00371-5.
  • 11. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44 Suppl 2:S27–S72. doi:10.1086/511159.
  • 12. Riquelme R, Torres A, el-Ebiary M, et al. Community-acquired pneumonia in the elderly. Clinical and nutritional aspects. Am J Respir Crit Care Med 1997;156(6):1908–1914. doi:10.1164/ajrccm.156.6.9702005.
  • 13. Fernández-Sabé N, Carratalà J, Rosón B, et al. Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine (Baltimore) 2003;82(3):159–169. doi:10.1097/01.md.0000076005.64510.87.
  • 14. Pişkin N, Aydemir H, Öztoprak N ve ark. Toplum kökenli pnömoni olgularında hastanede yatış süresi ve mortaliteyi etkileyen faktörler Mikrobiyol Bul 2009; 43: 597-606.
  • 15. Kobashi Y, Okimoto N, Matsushima T et al. Nihon Ronen Igakkai Zasshi 2001;38(3):312–316. doi:10.3143/geriatrics.38.312.
  • 16. Garibaldi RA. Epidemiology of community-acquired respiratory tract infections in adults. Incidence, etiology, and impact. Am J Med 1985;78(6B):32–37. doi:10.1016/0002-9343(85)90361-4.
  • 17. Ozmen I, Yıldırım E, Ogun H et al. Is the course of pneumonıa the same ın elderly and older patıent? Turkish Journal of Geriatrics 2016;19(4):203-10. 18. Kaplan V, Clermont G, Griffin MF, et al. Pneumonia: still the old man's friend? Arch Intern Med 2003;163(3):317–323. doi:10.1001/archinte.163.3.317.
  • 19. Loke YK, Kwok CS, Niruban A et al. Value of severity scales in predicting mortality from community-acquired pneumonia: systematic review and meta-analysis. Thorax 2010;65(10):884–890. doi:10.1136/thx.2009.134072.
  • 20. Kothe H, Bauer T, Marre R, et al. Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment. Eur Respir J 2008;32(1):139–146. doi:10.1183/09031936.00092507.
  • 21. Keating HJ 3rd, Klimek JJ, Levine DS et al. Effect of aging on the clinical significance of fever in ambulatory adult patients. J Am Geriatr Soc 1984;32(4):282–287. doi:10.1111/j.1532-5415.1984.tb02022.
  • 22. 23-valent pneumococcal polysaccharide vaccine. WHO position paper. Wkly Epidemiol Rec 2008; 83(42): 373-84.
  • 23. Jackson LA, Gurtman A, van Cleeff M, et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine compared to a 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naive adults. Vaccine 2013;31(35):3577–3584. doi:10.1016/j.vaccine.2013.04.0

Geriatri Kliniğinde Pnömoni Nedeniyle Takip Edilen Hastalarda Pnömokok Aşısının ve Diğer Faktörlerin Prognoza Etkisi

Year 2021, Volume: 11 Issue: 2, 238 - 245, 29.06.2021
https://doi.org/10.31832/smj.779500

Abstract

Objective: The aim of our study is to analyze the patients followed with the diagnosis of pneumonia in our geriatric clinic and discuss the effect of vaccination on prognosis by questioning the status of the vaccination before infection.
Materials and Methods: Patients who were diagnosed with pneumonia in the geriatric clinic between January 2017 and December 2017 were included in the study. Demographic data, symptoms, physical examination findings, laboratory tests and radiological examinations of the patients were recorded. Pneumococcal vaccination status before the development of pneumonia was evaluated. We classified the patients in terms of prognosis as ‘good’ and ‘poor’. Indicators of poor prognosis were determined by the presence of septic shock findings accompanying the infection, need for intensive care or death within 30 days of onset of infection.
Results: During the one-year period, a total of 47 (25%) patients with community or hospital acquired pneumonia in 186 hospitalized patients were recorded. The rates of chest x-ray findings and auscultation suggesting pneumonia were 87% and 83 %, respectively. The presence of dyspnea (p=0.008) and mental disorder (p<0.001) were significantly predictive for poor prognosis. CURB-65 (Confusion, uremia, blood pressure, age 65) (p=0.030) and PSI (Pneumonia severity index) (p=0.013) scores were significantly higher in patients with poor prognosis. Vaccinated patients had a statistically significantly better prognosis than the non-vaccinated (p= 0.003). All the patients who died (n= 7) did not have the vaccine.
Conclusion: This study demonstrated the necessity of vaccination and its positive effect on prognosis in the geriatric population.

References

  • 1. Crossley KB, Peterson PK. Infections in the elderly. Clin Infect Dis 1996;22(2):209–215. doi:10.1093/clinids/22.2.209.
  • 2. Lyons PG, Kollef MH. Prevention of hospital-acquired pneumonia. Curr Opin Crit Care 2018;24(5):370–378. doi:10.1097/MCC.0000000000000523. 3. Küçükardalı Y, Öncül O, Nalbant S ve ark. Yaşlı populasyonda toplum kökenli pnömoni olguları. Geriatri 2001; 4: 59-62.
  • 4. Hyattsville MD. Advance report of final mortality statistics: monthly vital statistics report: National Center for Health Statistics, 1987; DHHS publication no (PHS) 87-1120.
  • 5. Türk Toraks Derneği Erişkinlerde Toplumda Gelişen Pnömoni Tanı ve Tedavi Uzlaşı Raporu Türk Toraks Dergisi, 2009.
  • 6. Şenol E, Azap A, Erbay A et al. Pneumococcal vaccine as one of the immunization coverage targets for adulthood vaccines: A consensus report of the Study Group for Adult Immunization of the Turkish Society of Clinical Microbiology and Infectious Diseases]. Klimik Derg 2018.
  • 7. Cillóniz C, Amaro R, Torres A. Pneumococcal vaccination. Curr Opin Infect Dis 2016;29(2):187–196. doi:10.1097/QCO.0000000000000246.
  • 8. Berical AC, Harris D, Dela Cruz CS et al. Pneumococcal Vaccination Strategies. An Update and Perspective. Ann Am Thorac Soc 2016;13(6):933–944. doi:10.1513/AnnalsATS.201511-778FR.
  • 9. Sings HL. Pneumococcal conjugate vaccine use in adults - Addressing an unmet medical need for non-bacteremic pneumococcal pneumonia. Vaccine 2017;35(40):5406–5417. doi:10.1016/j.vaccine.2017.05.075.
  • 10. Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML. A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients. Am J Med 2000;108(8):609-613. doi:10.1016/s0002-9343(00)00371-5.
  • 11. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44 Suppl 2:S27–S72. doi:10.1086/511159.
  • 12. Riquelme R, Torres A, el-Ebiary M, et al. Community-acquired pneumonia in the elderly. Clinical and nutritional aspects. Am J Respir Crit Care Med 1997;156(6):1908–1914. doi:10.1164/ajrccm.156.6.9702005.
  • 13. Fernández-Sabé N, Carratalà J, Rosón B, et al. Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine (Baltimore) 2003;82(3):159–169. doi:10.1097/01.md.0000076005.64510.87.
  • 14. Pişkin N, Aydemir H, Öztoprak N ve ark. Toplum kökenli pnömoni olgularında hastanede yatış süresi ve mortaliteyi etkileyen faktörler Mikrobiyol Bul 2009; 43: 597-606.
  • 15. Kobashi Y, Okimoto N, Matsushima T et al. Nihon Ronen Igakkai Zasshi 2001;38(3):312–316. doi:10.3143/geriatrics.38.312.
  • 16. Garibaldi RA. Epidemiology of community-acquired respiratory tract infections in adults. Incidence, etiology, and impact. Am J Med 1985;78(6B):32–37. doi:10.1016/0002-9343(85)90361-4.
  • 17. Ozmen I, Yıldırım E, Ogun H et al. Is the course of pneumonıa the same ın elderly and older patıent? Turkish Journal of Geriatrics 2016;19(4):203-10. 18. Kaplan V, Clermont G, Griffin MF, et al. Pneumonia: still the old man's friend? Arch Intern Med 2003;163(3):317–323. doi:10.1001/archinte.163.3.317.
  • 19. Loke YK, Kwok CS, Niruban A et al. Value of severity scales in predicting mortality from community-acquired pneumonia: systematic review and meta-analysis. Thorax 2010;65(10):884–890. doi:10.1136/thx.2009.134072.
  • 20. Kothe H, Bauer T, Marre R, et al. Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment. Eur Respir J 2008;32(1):139–146. doi:10.1183/09031936.00092507.
  • 21. Keating HJ 3rd, Klimek JJ, Levine DS et al. Effect of aging on the clinical significance of fever in ambulatory adult patients. J Am Geriatr Soc 1984;32(4):282–287. doi:10.1111/j.1532-5415.1984.tb02022.
  • 22. 23-valent pneumococcal polysaccharide vaccine. WHO position paper. Wkly Epidemiol Rec 2008; 83(42): 373-84.
  • 23. Jackson LA, Gurtman A, van Cleeff M, et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine compared to a 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naive adults. Vaccine 2013;31(35):3577–3584. doi:10.1016/j.vaccine.2013.04.0
There are 21 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Veysel Suzan 0000-0001-5741-9820

Hakan Yavuzer 0000-0003-2685-6555

Osman Faruk Bayramlar 0000-0001-7311-3258

Tuğçe Emiroğlu This is me 0000-0002-5550-6477

Pınar Arman This is me 0000-0002-8228-2165

Rabia Bağ Soytaş 0000-0002-9620-7596

Damla Ünal This is me 0000-0002-4424-3800

Serkan Sürme 0000-0001-7239-1133

Emir Celik 0000-0001-8440-3082

Alper Döventaş 0000-0001-5509-2625

Deniz Suna Erdinçler This is me 0000-0003-1208-4750

Publication Date June 29, 2021
Submission Date August 12, 2020
Published in Issue Year 2021 Volume: 11 Issue: 2

Cite

AMA Suzan V, Yavuzer H, Bayramlar OF, Emiroğlu T, Arman P, Bağ Soytaş R, Ünal D, Sürme S, Celik E, Döventaş A, Suna Erdinçler D. Geriatri Kliniğinde Pnömoni Nedeniyle Takip Edilen Hastalarda Pnömokok Aşısının ve Diğer Faktörlerin Prognoza Etkisi. Sakarya Tıp Dergisi. June 2021;11(2):238-245. doi:10.31832/smj.779500

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